Clinical overview
Insomnia disorder is dissatisfaction with sleep plus daytime impairment, at least three nights a week for three months when chronic. Psychiatric clinics see a large share of secondary insomnia: depression, GAD, PTSD nightmares, SSRI activation, perimenopausal night sweats, and stimulant timing. We are not a sleep laboratory. Loud snoring, witnessed apneas, and resistant hypertension still need a sleep-medicine referral.
How we evaluate
We timeline sleep opportunity vs sleep ability, caffeine, alcohol, screens, shift work, and nightmare content. Medications that fragment sleep are reviewed. Hormone context (vasomotor symptoms, low testosterone with sleep fragmentation) is relevant when present. A home sleep test is not ordered as a wellness upsell; it is indicated by apnea signs.
Treatment stance
CBT-I principles, stimulus control, and treating the parent psychiatric diagnosis come before chronic hypnotics. When medication is used, we document indication and duration (for example a time-limited hypnotic, doxepin, or trazodone in selected patients). Melatonin is not a diagnosis. Massage and sleep hygiene help some people; they do not replace apnea treatment.
When to seek care
Book when insomnia is driving mood or function and a psychiatric driver is likely. Seek emergency care for suicidal insomnia with agitation, or urgent sleep medicine for falling asleep while driving.